General Surgical Unit Research Articles

OGBN P14 The development, introduction and outcomes of an electronic, patient record-based, Morbidity and Mortality (M&M) reporting system

Abstract Background Recording of patient complications and outcomes has suffered from the lack of a standardised reporting system. The aim of this project was to develop and introduce within our health board a generic M&M reporting tool for all surgical and medical specialities which would allow agreed outcomes and actions, following open discussion at M&M meetings, to be documented in the electronic patient record (EPR). Methods TrakCare® (Intersystems) is the electronic patient management system used within our region to record and store information for patient consultations, investigations and treatments. The criteria felt essential were for a reporting system that was suited to all disciplines, accessible to all levels of staff, interlinked between specialities and allowed analysis and reporting of outcomes. Access to all aspects of the EPR including results and imaging should be available during the M&M meeting to facilitate informed discussion. Agreement was reached on the required drop down menus which included patient details, background/event timeline, death certification, end-of-life care, clinical governance, lessons learned and actions and outcomes. ICD-10 codes were used for diagnosis and OPCS-4 coding for procedures. A complication list was developed with word recognition of either the organ system or the complication. Complications were graded according to the Clavien-Dindo classification. All entered data was analysed using Business Intelligence. Results The development process lasted 9 months with the input of the author and programmers from the TrakCare® team. The system was first introduced in September 2017 within the general surgical unit. 1855 patients have been discussed at the general surgical M&M meetings using the system. Since introduction, an additional 37 specialities have adopted the electronic M&M reporting tool. To date 4859 patients in total have been discussed. The introduction of the system has resulted in additional improvements to the M&M process including the requirement for a designated chairperson, a meeting attendance record and documentation of actions and outcomes from meetings. Automatically generated reports show all outstanding actions and recommendations identified at M&M meetings to ensure that the full process is completed. Conclusions The widespread adoption of a standardised M&M reporting tool clearly shows the willingness of care providers to engage in open discussion and learning from M&M meetings. The introduction of a standardised electronic reporting tool has led to additional improvements in the M&M process.

EGS P06 Delays in Operating on General Surgery Patients Causes Increased Morbidity and Burden on the NHS

Abstract Background The number of patients waiting for an operation in the United Kingdom has never been higher, as of February 2022 over six million people were waiting for treatment. There is pressure nationally on trusts to implement strategies aimed at reducing the backlog of elective procedures. Long waiting lists can lead to a greater demand on acute surgical services as patients require treatment for their condition while they wait for their procedure. This study aims to determine the impact that long waiting lists have on patients, and how readmissions affect acute services in a busy tertiary General Surgical unit in England. Methods Snapshot data was captured on a single day in February 2022 using the trust patient records system combined with the General Surgical waiting list. Data was collected and analysed in a bespoke excel data management tool built by the trusts patient costings team. The tool allows detailed analysis of patients readmitted whilst on the waiting list, outcomes and total cost. It also allows the data set to be explored as a whole and detailed patient level analysis. Wait time for emergency procedures was also analysed by length of pre-op and post-op stay. Results A total of 2902 patients were awaiting a General Surgical procedure in February 2022, with an average wait of 34 weeks. 394 (14%) of these patients have attended acutely since being listed for elective surgery. The total cost implication of these reattendances is £563,766. Analysis of a single procedure, such as laparoscopic cholecystectomy revealed 183 patients waiting for a cholecystectomy. 20% of these presented acutely, of which 68% was directly related to the listed underlying pathology with 34 bed days lost. 261 patients were awaiting a hernia (inguinal, umbilical, incisional) repair. 20% of these patients presented acutely whilst on the waiting list, with 33 lost bed days. Acute attendances increase as the waiting time increases; 38% of patients waiting over 15 months attend acutely, increasing to 50% at 22 months. Data from emergency procedures showed that as inpatient length of stay (LOS) pre-operatively increased in number of days, the post-operative LOS increased proportionally. Pre-op LOS of 1–2, 2–3, 3–4, 4–5, ≥5 led to post-op LOS of 2.9, 2.9, 4.2, 5.9 and 8.7 respectively. Conclusions This study highlights that long waiting lists can lead to significant burden on acute General Surgical services as patients seek medical attention for the condition they are awaiting surgical management for, leading to costs of over half a million pounds. The problem becomes intensified by lost bed days due to these acute presentations, which can lead to cancelled elective procedures and pressure on acute surgical services. This results in emergency patients waiting longer in-hospital for an operation, who then have a longer post-operative LOS. Combined these findings suggest a higher morbidity for these patients. There is an urgent need for innovative strategies to reduce waiting lists, and increase theatre productivity. Data analysis tools like these allow trusts to nuance strategies to address these issues directly.

SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study

PurposePost-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes. MethodsWe used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed. ResultsThe cohort consisted of 419 adult patients between the ages of 16–94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay. ConclusionsSHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

EP-410 Improving data quality for emergency surgery: the effect of a dedicated NELA Fellow in a general surgical unit

Abstract Aims The National Emergency Laparotomy Audit (NELA) has been running for over 8 years; despite this, there are still difficulties faced by some units and clinicians in having time and space to contemporaneously enter data and keep up to date. This study describes the improvements made to data quality after the introduction of a dedicated NELA Surgical Fellow in a single surgical centre. The role of the Fellow has been to liaise and engage with all members of the surgical team regularly to highlight the importance of accurate and timely data entry and, further, to produce monthly summaries of all emergency laparotomies and name surgeons who have not entered data. Methods The post of NELA Surgical Fellow was introduced at our DGH general surgical unit in August 2021. All patients who were entered onto the NELA database from our unit from January 2021 to July 2021 were compared to those entered onto the database after the introduction of the NELA Fellow. Results After the introduction of the NELA Surgical Fellow, contemporaneous data collection for patients has increased from 67% to 89% and the proportion of patients with complete data fields within a week after surgery has increased from 62% to 85%. The average time to complete data entry has fallen from 67 days after surgery to 52 days. Conclusions The introduction of a dedicated NELA Surgical Fellow, and the increased commitment to timely data collection, has led to improved accuracy of data and a faster completion time within just six months.

TH6.9 Does the management of right iliac fossa pain vary between men and women?

Abstract Aims Recent studies have suggested that women are more likely to suffer a bad outcome after surgery compared to men with similar findings in healthcare areas including pain management and diagnosis. This study aimed to assess the management of female patients with right iliac fossa (RIF) pain. Methods Patients who presented to a DGH general surgical unit with RIF pain from March to October 2020 were identified from a prospectively maintained database of admissions. Clinical parameters, management and final diagnosis were recorded. Minimum follow-up was 12 months (October 2021) to identify re-admissions and morbidity. Results There were 417 patients; 274 (66%) were women. Women were more likely to have an ultrasound (39% vs. 4%, P<0.001) and less likely to have a CT (60% vs. 67%, P=0.250), though they had the same proportion of normal CT imaging (33% vs. 34%). Men were more likely to undergo surgery (49% vs. 29%, P<0.001) but, despite this, women were more likely to have a diagnostic laparoscopy alone or a normal appendix after appendicectomy (15% vs. 4%). The proportion of women without a definitive diagnosis was greater (39% vs. 32%, P=0.024) and only 4 women were referred on for further investigations leading to a greater proportion of re-admissions with ongoing pain amongst women. Conclusions More women than men with RIF pain did not have a diagnosis and women were more likely to have ‘unnecessary’ surgery. Closer attention to gynaecological past medical history or symptoms may improve diagnostic yield and management of women with RIF pain.

COVID-19 Diagnosis in Patients With Acute Abdominal Pain Without Respiratory Symptoms: A UK Emergency General Surgical Unit Experience.

BackgroundRecent evidence has emerged reporting atypical clinical symptoms of the novel coronavirus (COVID-19). There is a sparsity of existing studies examining COVID-19-related abdominal pain and the role of investigative imaging for the virus in these patients. Study aims were to determine COVID-19 incidence in those with acute abdominal pain in the absence of respiratory symptoms and to assess the diagnostic performance of CT thoracic imaging in such patients.MethodsRetrospective analysis of all consecutive patients admitted to our emergency general surgical unit between 1st March 2020 and 31st May 2020 was performed. In adherence with national guidelines, all patients underwent nasal and oro-pharyngeal COVID-19 RT-PCR swabs as well as thoracic and abdominal computed tomography (CT) on admission.ResultsFrom 112 patients admitted with acute abdominal pain in the absence of respiratory symptoms, 16 (14.3%) tested positive for COVID-19 on RT-PCR swab testing. Overall, 50% (8/16) of these patients had no intra-abdominal pathology on CT. The sensitivity and specificity of CT thoracic imaging for diagnosing COVID-19 was 43.8% and 91.7%, respectively. Patients with positive COVID-19 swabs had higher C-reactive protein levels, lower potassium levels and a higher proportion of those with a low lymphocyte count.DiscussionOne in seven patients with abdominal pain without any respiratory symptoms tested positive for COVID-19. Half of these patients represented COVID-19 manifesting primarily as acute abdominal pain. Combined swab testing and CT imaging should be performed in all abdominal pain presentations due to the varying diagnostic performance of thoracic CT in diagnosing COVID-19.

Surgical Management of Secondary Peritonitis Patients in a Tertiary Care Hospital

Background: In the majority of general surgical units around the world, Secondary Peritonitis is the common surgical emergency and has high risk of morbidity and mortality. The present study was done to evaluate the surgical management among Secondary Peritonitis cases in a tertiary care Hospital. Material and Methods: This cross sectional study was conducted by Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 among patients with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: A total of 250 individuals with a diagnosis of perforation peritonitis were assessed in the current study. Males made up 205 (82%) of the total while females made up 45 (18%). The patients' average age was 47.28 17.34 years, ranging from 18 to 87. In the study, 99 (39.6%) of the total patients were under the age of 40, while 151 (60.4%) were beyond the age of 40. Of the total, 32 (12.80%) passed away while 218 (87.20%) were discharged after receiving treatment. In the present study, most of patients 89 (35.6%) of secondary peritonitis were managed by Cellan jones repair followed by Loop ileostomy in 43 (17.2%) patients End ileostomy in 27 (10.8%) patients and rest by other procedures. Conclusion: The study concluded that most of patients of secondary peritonitis were managed by Cellan jones repair followed by Loop ileostomy and End ileostomy.

Somatic symptom severity association with healthcare utilization and costs in surgical inpatients with an episode of abdominal pain.

BackgroundSomatic syndromes are present in 30 per cent of primary healthcare populations and are associated with increased health service use and health costs. Less is known about secondary care surgical inpatient populations.MethodsThis was a prospective longitudinal cohort study (n = 465) of consecutive adult admissions with an episode of non-traumatic abdominal pain, to the Acute General Surgical Unit at a tertiary hospital in New South Wales, Australia. Somatic symptom severity (SSS) was dichotomized using the Patient Health Questionnaire (PHQ)-15 with a cut-off point of 10 or higher (medium–high SSS) and compared pre-admission and during admission. Total healthcare utilization and direct costs were stratified by a PHQ-15 score of 10 or higher. Linear regression was used to examine differences in costs, and a multivariable linear regression was used to examine the relationship of PHQ-15 scores of 10 or higher to total costs, reported as mean total costs of care and percentage difference (95 per cent confidence intervals).ResultsFifty-two per cent (n = 242) of participants had a medium–high SSS with greater pre-admission and admission interval health service costs. Mean total direct costs of care were 25 per cent (95 per cent c.i. 8 to 44 per cent) higher in the PHQ-15 score of 10 or higher group: mean difference €1401.93 (95 per cent c.i. €512.19 to €2273.67). The multivariable model showed a significant association of PHQ-15 scores of 10 or higher (2.1 per cent; 0.2–4.1 per cent greater for each one-point increase in score) with total hospital costs, although the strongest contributions to cost were older age, operative management, and lower socioeconomic level. There was a linear relationship between PHQ scores and total healthcare costs.ConclusionsMedium to high levels of somatic symptoms are common in surgical inpatients with abdominal pain and are independently associated with greater healthcare utilization.

Prognostic Relevance of Pre- and Postoperative Arterial Blood Lactate Measurements, Procalcitonin and pH as Predictors of Outcomes in Secondary Peritonitis

Secondary peritonitis is the most common form that follows an intra-peritoneal source usually from perforation of hollow viscera. Acute generalized peritonitis due to underlying hollow viscous perforation is a critical & life-threatening condition. It is a common surgical emergency in most of the general surgical units across the world. It is often associated with significant morbidity and mortality. In the present study Perforation peritonitis is associated with 12.8% mortality. Initial lactate, postoperative (24 hours) lactate is significant variables for mortality with critical values up to 3.78 mmol/L and 3.67 mmol/L respectively. Initial lactate, postoperative (24 hours) lactate values up to 2.29 mmol/L and 1.45 mmol/L respectively were reported in case of survivors. The lactate value of more than 2.5 mmol/L ascertained to have 64 % mortality. Initial pH, postoperative (24 hours) pH are significant variables for mortality with critical value of 7.16 and 7.17 respectively. Initial pH, postoperative (24 hours) pH value of 7.36 and 7.38 respectively were reported in case of survivors. Procalcitonin values of more than 2.58 ng/ml (normal range 0.01-0.05 ng/ml) ascertained to have 56.25 % mortality.

Practice of Person-Based Discharge Communication Practices in General Surgery Wards at The Kenyatta National Hospital

Purpose: The current study sought to investigate the practice of person-based discharge communication practices in general surgery wards at the Kenyatta National Hospital.
 Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis.
 Results: The findings show that 77 of the respondents in the Neurology unit (mean = 2.97), 51 of them in the general surgical unit (mean = 1.80) and 52 of them in the urology unit (mean = 2.11) agreed that person-based discharge communication practices affect patient health outcomes. There was also a significant difference between the mean responses of the patients in the Neurology ward and Urology ward (-.267*, P=0.026). Likewise, there was a significant difference between the mean responses of the patients in the Urology ward and General surgery ward (-0.313*, P=0.017). Furthermore, the findings indicated that there is a statistically significant relationship between person-based discharge communication practices at KNH given the Neurology ward, Urology ward and General surgery ward departments {(F (2, 177) =3.517, p=0.032< 0.05}. This was supported by the regression findings that indicated that person-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β= 0.305, p=0.000). This implies that improvement in one unit of person-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true).
 Unique contributions to theory, policy and practice: Based on the study findings, the current study, therefore, recommends the health care practitioners to continuously appreciate the importance placed on constant and regular use of this discharge communication for better patient health outcomes and staff satisfaction, as well as contribute to cost savings to the organization.

Routine ultrasound for suspected appendicitis in children: a single-centre retrospective cohort study.

Appendicitis continues to be a common surgical emergency in children, but its diagnosis remains challenging. Use of diagnostic imaging to confirm appendicitis has gained popularity in some countries because it is associated with lower negative appendicectomy rates. This study reports our centre's experience of adopting routine ultrasound for the investigation of suspected appendicitis in children. A single-centre retrospective cohort study was performed investigating all children aged 5-16 years admitted under surgeons with suspected appendicitis, in January-December 2019. Primary outcomes were the rate of ultrasound use, its accuracy in diagnosing/excluding appendicitis and negative appendicectomy rate. Other outcomes were treatment received, length of stay and complications. The majority of the 193 children with suspected appendicitis underwent a diagnostic ultrasound (87.5%). Ultrasound was highly sensitive (0.90, 95% confidence interval (CI) 0.81-0.96) and specific (1.0, 95% CI 0.96-1.0) for appendicitis in this study. Negative appendicectomy rate was extremely low (1.4%). Laparoscopic appendicectomy was the preferred management (75/86), with one case started open and no conversions to open. A minority of cases of simple appendicitis (10/86) were treated primarily with antibiotics. Rates of complex appendicitis and postoperative complications were similar to other studies. Ultrasound can be highly sensitive and specific for appendicitis. Its routine use to confirm appendicitis prior to surgery is associated with a low negative appendicectomy rate. This is a major change in practice for a general surgical unit in the United Kingdom.

Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training.

BackgroundAlthough surgery is essential in healthcare, a significant number of patients suffer unfair harm while undergoing surgery. Many of these originate from failures in non-technical aspects, especially communication among operators. A surgical safety checklist is a simple tool that helps to reduce surgical adverse events, but even if it is fast to fill out, its compilation is often neglected by the healthcare workers because of unprepared cultural background. The present study aims to value the efficacy of a free intervention, such as a short training about risk management and safety checklist, to improve checklist adherence.MethodsIn March 2019, the medical and nursing staff of the General Surgical Unit attended a two-lesson theoretical training concerning surgical safety and risk management tools such as the surgical safety checklist. The authors compared the completeness of the surgical checklists after and before the training, considering the same period (2 months) for both groups.ResultThe surgical safety checklists were present in 198 cases (70.97%) before the intervention and 231 cases (96.25%) after that. After the training, the compilation adherence increased for every different type of healthcare worker of the unit (surgeons, nurses, anesthetists, and scrab nurses). Furthermore, a longer hospitalization was associated with a higher surgical checklist adherence by the operators.ConclusionsThe results showed that a free and simple intervention, such as a two-lesson training, significantly stimulated the correct use of the surgical safety checklist. Moreover, the checklist adherence increased even for the operators who did not attend the training, maybe because of the positive influence of the colleagues' positive behaviors. As the results were promising with only two theoretical lessons, much more can be done to build a new safety culture in healthcare.

Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study

ObjectiveTo assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.DesignBefore and...

EP.FRI.376 Early Routine CT Scans for All Surgical Admissions for Abdominal Pain May Improve Patient Outcomes

Abstract Aim Acute abdominal pain remains a diagnostic challenge in the Emergency Department (ED) as pathologies can involve various surgical craft groups. Computed tomography (CT) enables accurate diagnosis of abdominal pathologies. However, with pressures on ED such as the “4 hour rule” established by the Australian NSW Health Emergency Performance Plan, there may be resistance or omission of early CT in ED. We hypothesise that early, routine CT in adult patients presenting with acute abdominal pain requiring hospital admission improves patient outcomes by increasing diagnostic and referral accuracy. This study compares the proportion of correct ED diagnosis of abdominal pain presentations with and without formal imaging reports. Methods Data from 118 patients presenting with abdominal pain are collected prospectively in a regional hospital and analysed. Patient demographics, imaging results, initial ED diagnosis and final discharge diagnosis are further examined. Results Out of the 118 patients who had abdominal pain, 32 patients obtained complete imaging with a radiology report whilst 86 patients either did not have any imaging performed or was referred to a general surgical unit prior to obtaining a formal report. Among the patients who had imaging reported, 78% (n = 25/32) had the correct diagnosis, whilst those without a radiology report had a 52% (n = 45/86) diagnostic accuracy. This demonstrates an improved accuracy of diagnosis or reduced error rate of 26% when a scan report is available (p = 0.01). Conclusion Early, routine CT with formal reporting significantly reduces diagnostic error rates and increases accurate referral. This allows accurate diagnosis and improves patient outcomes.

1502 UK National Survey of Huber Needle Availability for Deflation of Gastric Band Balloon in The Acute Setting

Abstract Introduction The laparoscopic gastric band was popularised in the 1990’s. The procedure involves placement of an adjustable band around the proximal stomach, aiming to induce satiety and offering a surgical solution to morbid obesity. Complications such as band slippage and erosion, together with succession by sleeve gastrectomy and gastric bypass which offer more significant weight loss has meant the procedure has gone out of favour. However, their legacy continues with a stream of patients presenting annually with complications, many of whom have travelled abroad for the procedure. The aim of this study was to examine Huber needle availability in acute surgical units nationally. Method All acute general surgical admission units across the UK were identified from the National Emergency Laparotomy Audit database. The senior nurse managing each unit was contacted by telephone and asked three questions; whether their hospital has an elective bariatric service on site, whether they review acute bariatric emergencies and whether the unit stocks Huber needles. Results 151 acute general surgical units were identified across the UK, of which 60% responded. 30/90(33%) have an elective bariatric service on site and 65/90(72%) reviewed acute bariatric patients. 8/90(8.9%) stock Huber needles for the acute deflation of gastric bands. Conclusions Patients presenting acutely with gastric band complications typically need urgent deflation of the gastric band. The Huber needle is a non-coring needle used for gastric band adjustment, preventing damage to the port. The Huber needle is a low-cost item and should be stocked by all acute general surgical units.

Effect of virtual reality application on preoperative anxiety level among children undergoing surgery

Background: Children who undergo surgical operations may experience preoperative anxiety and they needed to both physical and psychological preparation. The aim: the study aimed to determine the effect of virtual reality application on preoperative anxiety levels among children undergoing surgery. Subject and Methods: Design: A quasi-experimental research design was utilized to achieve the study's aim. Setting: The study was applied in the General Pediatric Surgical Unit at Sohag University Hospital. Sample: A purposive sample of 100 children aged from 4-8 years was included, randomly assigned equally into a study and control group (The study group involved 50 children, who used virtual reality technology and 50 children in the control group using routine care only. Two tools were used to collect data: (I) Interview Structured Questionnaire developed by the researchers and (II) State-Trait Anxiety Inventory for Children. Results: The study result showed that preoperative anxiety scores were lower among children after the virtual reality application than among children in the control group. There were highly statistically significant differences detected between the total mean score of anxiety scores in the pretest and posttest before surgery (P=0.000).

Patterns of Laryngeal Nerves Injuries Following Thyroid Surgery in Al-Imamein Al-Kadhmein Medical City

Background: Morbidity after thyroid surgery related to injuries to parathyroid, recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN), mostly due to unawareness of the anatomical variations and lack of meticulous dissection added to that patient comorbidity and type of goiter. Objective: To assess the incidence of nerves injuries (RLN and EBSLN) and evaluation of the risk factors for nerves injuries. Methods: A prospective study included 250 patients admitted to the General Surgical Unit at Al-Imamein Al-kadhimein Medical City from the first of October 2014 to the end of October 2017. Evaluation of nerves injuries (RLN and EBSLN) with regard to thyroid pathology, types of resection, age and gender. Thyroidectomies were done by different surgical teams. Patients with recurrent goiter, prior cervical surgery and preexisting vocal cord paralysis were excluded. Vocal cords assessment was done preoperatively, intraoperatively at time of extubation and postoperatively. Patients with injury to the RLN were managed accordingly and followed up by serial examination for 6-12 month, while patients with symptoms of EBSLN injuries were followed depending just on clinical feature due to lack of diagnostic facilities. Results: There were 78 (31.2%), 172 (68.8%) male and females subsequently. The age range was (18-70) years and mean±SD was (44±11.9). Multinodular goiter was the main presentation in (168 patients), while thyroiditis was the least (6 patients). Injury to RLN was reported in 8 (3.2%) patients, 3 had unilateral and 5 had bilateral. Permanent damage documented in 2 patients. There was a significant RLN injury association with malignancy and total thyroidectomy. EBSLN injury have been reported in 55 patients (22%), it was transient in 43 patients and permanent in 12 patients. Conclusion: Nerve damage after thyroidectomy is not uncommon and affect significantly on quality of life. Careful dissection and awareness of anatomical variation is essential. Majority of injuries were transient and recovered spontaneously. Immediate intervention is not recommended unless airway compromisation ensure. Keywords: RLN, EBSLN, thyroidectomy Citation: Jaber SMA, Abdulhassan BA, Hussien HK, Al-Helfy SH. Patterns of laryngeal nerves injuries following thyroid surgery in Al-Imamein Al-Kadhmein Medical City. Iraqi JMS. 2021; 19(1): 10-17. doi: 10.22578/IJMS.19.1.2

Palliative Care Education: Its Effect on Nurses’ Competency during Care of Dying Patients

Background: Palliative care can play a major role in relieving both physical and mental symptoms of the dying patient. Nurses are the key valuable palliative care team members who are responsible for the dimension of physical, functional, social, and spiritual patients' care. Essential factors affecting a successful implementation of palliative care are nurses' knowledge, attitude and self efficacy for providing care to these patients. Aim of the study: To examine impact of palliative care education on nurses’ competency during care for dying patients. Methods: A quasi-experimental design was utilized. Setting: The study was conducted at oncology institute, general medical and general surgical unit of Menoufia University hospital. Subjects: A convenience sample of 120 nurses (52 from oncology institute, 34 from general medical and 34 general surgical unit) of Menoufia University who agreed to participate in this study were divided alternatively and randomly into two equal groups, 60 for group 1 and 60 for group 2.Tools: four tools were utilized by the researchers. Tool I: Structural interviewing questionnaire, Tool II: Palliative Care Quiz for Nursing, Tool III: The Frommelt Attitudes Toward Care of the Dying scale and Tool IV: The Palliative Care Self-Efficacy Scale. Results: the mean total score of Palliative Care nurses’ knowledge in study group (16.48±1.88)was better than control group (7.23± 2.68), nurses' attitude toward palliative care of study group was 113.50±10.75 as compared to 91.21±12.40of control group and palliative care self-efficacy score of study group was 28.06±7.38 as compared to16.08±4.49 of control group at post-intervention. Conclusion: palliative care educational intervention to nurses can be effective in strengthening their knowledge base, improving attitude and level of self efficacy toward care of dying patient. Recommendations: Education and training programs about palliative care with simple illustrated booklet required for all nursing staff in health care setting

26 COVID-19 Diagnosis in Patients with Acute Abdominal Pain Without Respiratory Symptoms: A UK Emergency General Surgical Unit Experience

IntroductionEvidence has emerged reporting atypical symptoms of the coronavirus (COVID-19). There is a sparsity of existing studies examining COVID-19 related abdominal pain and the role of investigative imaging for the virus in these patients. Study aims were to determine COVID-19 incidence in those with acute abdominal pain in the absence of respiratory symptoms and to assess the performance of Computer Tomography (CT) thoracic imaging.MethodRetrospective analysis of all patients admitted to our emergency general surgical unit between 1st March 2020 and 31st May 2020 was performed. All patients underwent nasal and oro-pharyngeal COVID-19 RT-PCR swabs as well as CT on admission.ResultsFrom 112 patients admitted with acute abdominal pain in the absence of respiratory symptoms, 16 (14.3%) tested positive for COVID-19 on RT-PCR swab testing. 50% (8/16) of these patients had no intra-abdominal pathology on CT. The sensitivity and specificity of CT thoracic imaging for COVID-19 was 43.8% and 91.7%.ConclusionsOne in seven patients with abdominal pain without any respiratory symptoms tested positive. Half these patients represented COVID-19 manifesting primarily as acute abdominal pain. Combined swab testing and CT imaging should be performed in all abdominal pain presentations due to the varying diagnostic performance of thoracic CT in diagnosing COVID-19.